ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

V R MuraleedharanSubscribe to V R Muraleedharan

Invest More in Public Healthcare Facilities

Data from National Sample Surveys (71st round, 2014 and 75th round, 2017–18) show that there is a significant increase in the utilisation of public facilities for both outpatient and inpatient services, across empowered action group states and non-EAG states. As a result, there is a dramatic fall in the overall financial burden on patients who would have otherwise used services of private healthcare providers. In light of this evidence, this paper argues that it is prudent to invest more directly to strengthen public healthcare delivery system in India.

Cost-effectiveness Threshold and Health Opportunity Cost

With the setting up of the health technology assessment board, evidence from cost-effectiveness analysis will play an important role in decision-making. This raises the fundamental question: How much extra cost per unit of health gained is considered cost-effective? Various approaches for assessing the appropriate cost-effectiveness threshold for India are discussed. A robustly determined opportunity cost of healthcare spending should serve as a proxy for setting up a CET, and it should be used to advocate for greater resources towards achieving universal health coverage.

No Respite for Public Health

Health allocations in Budget 2016-17, which show a modest increase in nominal terms, must be viewed against the virtual stagnation of allocations since 2010-11, and the major cuts of 2015-16. Meanwhile, state governments' investments in health grew steadily. The centre has only prioritised initiatives that stimulate private health sector growth. This approach will have immediate adverse effects on availability and quality of public health services and will cause impoverishment due to healthcare costs, compromising economic growth in the long run.

NSSO 71st Round Data on Health and Beyond

The overarching policy question in private expenditure on health that we should all be addressing is, “What must the government do to reduce the debilitating (financial) effects of out-of-pocket healthcare expenditure of people?” A response to a comment (EPW, 21 November 2015) on the authors’ earlier piece (EPW, 15 August 2015).

Falling Sick, Paying the Price

The decennial National Sample Survey on health and education provides useful information on the health and education of the population. The summary report on health from the 71st round conducted in 2014 allows us to make an initial assessment of three sets of issues. One, the trends in morbidity rates and patterns of morbidity, two, the effectiveness of the public sector in ensuring access to healthcare, and three, the cost of healthcare across public and private sectors.

Measuring Progress towards Universal Health Coverage

This paper proposes an approach to periodically measure the extent of progress towards universal health coverage using a set of indicators that captures the essence of the factors to be considered in moving towards universalisation. It presents the rationale for the approach and demonstrates its use, based on a primary household survey carried out at the district level. Discussing the strengths and limitations of the approach, it points to how these measures could be further refined. The effort is to find a method of measurement that will apply to any of the alternative ways of progressing towards universal health coverage, however defined and implemented.

Universal Health Coverage

For India to improve the existing government health system is far less complex than expanding health insurance. International experience shows the difficulties of regulating an insurance-based system to keep costs down and assure quality.

Health Care From Policy to Practice

has preached" in ideological political economic policy (p 341), and argues that the west needs its own perestroika to do the same: Give up its agricultural, multifiber textile, services, intellectual property and other protectionist policies, which cost the developing countries between three and ten times as much as they receive through western development 'assistance'. "All this comes about because we lack vision in the west" (p 345) he says without considering to what extent this lack of 'vision' is the reflection of structural interests. So he proposes a "second Copernican revolution, as it were" centred not separate sovereign states, but on "a system in which nation states revolve around a set of shared core values regarding human survival and human solidarity" [p 349]. Instrumental would be some global or at least initially inter-regional [e g, Euro- Indian] 'development contracts', as already proposed by the Norwegian minister Thorwald Stoltenberg, which would commit both contracting parties to 'reciprocal conditionally' and equitably shared economic sacrifices and benefits. Good luck! Gerrit Faber proposes similar arrangements to combat the global greenhouse effect. Each country should receive a population based quota for maximum carbon dioxide and other emissions, which should also be subject to a global 'carbon tax'. To reduce these by half globally, countries in the north [west and east] would have to reduce their present emissions by 70 to 90 per cent, China could maintain them, and India and Brazil could about double them. Therefore, the latter and also less polluting Africa should be allowed to 'sell' part of their allocated quotas to bidders in the rich over-polluting countries. Last but not least, Paul de Waart confronts 'Implementing, Human Rights: Good Governance as a United Nations Concern' and Rhamatullah Khan The United Nations, Good Governance and Global Governance'. While the World Bank's World Development Reports are limited to economic growth and poverty, the recently inaugurated Human Development Report also introduces an index of human freedom reflecting three of Roosevelt's four freedoms of speech, religion and from fear, but conspicuously omitting the fourth one of freedom from want. "Given that all human freedoms are interdependent and inseparable...a truly democratic society should take economic, social and cultural rights just as seriously" as individual political ones (pp 373, 369). So much for indexing these rights. However promoting and protecting them, even the political ones, is even more problematic in a world of sovereign states in which "in a nutshell, the UN Charter has not provided an administration able to call states found guilty of bad governance to order" (p 376). On the contrary, as Khan documents, the UN was designed [but as we know does not even do well] as a peace- enforcer and nor as a 'good governance' law- enforcer, unless intra-state violation of law or human rights directly threatens inter-state world peace and 'global governance'. Nor is the UN, even or especially after the 1992 Earth Summit in Rio de Janeiro, entitled or empowered to promote 'global governance' by meddling in the 'internal' affairs of sovereign states that unduly pollute the common global environment. Moreover, today it is especially the weak states of the south who jealously try to defend their 'sovereignty' against any possible encroachments by a UN whose Security Council executive is dominated by a few powerful states in the west and two in the [former] east, as was graphically shown on TV screens worldwide during the 'United Nations' war against Iraq. Today, Bosnia, Somalia, and Ruwanda again demonstrate the legal and practical ineffectiveness of the UN in protecting, let alone promoting, either good governance or global governance. And any legal and practical alternative "could be twisted by the Great Powers into an inquisitorial undertaking against the poor and weak... [so that] a global design that enables the UN to suspend state sovereignty in situations of alleged or proven incapability of the national authorities to govern, or when anarchic conditions prevail, we cannot help but oppose", as Khan writes in his closing sentence (pp 396, 398).

Health Care in Panchayati Raj

Health Care in Panchayati Raj V R Muraleedharan People's Health in People's Hands: A Model for Panchayati Raj edited by N H Antia and Kavita Bhatia; Foundation for Research in Community Health, Bombay, 1993; pp ix+394, Rs 100 (paperback).

Diet, Disease and Death in Colonial South India

There is an abundance of evidence to suggest that a large number of the people in colonial south India suffered continually from a number of deficiency diseases. Their susceptibility to these diseases was a result of inadequate diets. However, the nutrition-mortality link has not received adequate attention so far.

Health and Human Resources Development

witnesses and documents. The ordinance is silent on whether the commission will conduct its enquiry in public or not. The main purpose of the commission being to ventilate and highlight violation of human rights with a view to preventing its recurrence, it is very important that the commission's enquiries be held in public and all the relevant documents arc made public.


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